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Background: The diagnostic performance of the high‐sensitivity troponin T (hs‐cTnT) 0/2‐h algorithm is unclear among U.S. emergency department (ED) patients with acute chest pain. Methods: A preplanned subgroup analysis of the STOP‐CP cohort study was conducted. Participants with 0‐ and 2‐h hs‐cTnT measures prospectively enrolled at eight U.S. EDs from January 2017 to September 2018 were stratified into rule‐out, observation, and rule‐in zones using the hs‐cTnT 0/2‐h algorithm alone and combined with the history, electrocardiogram, age, and risk factor (HEAR) score. The primary outcome was adjudicated 30‐day cardiac death or myocardial infarction (CDMI). The sensitivity and negative predictive value (NPV) of the 0/2‐h rule‐out zone and specificity and positive predictive value (PPV) of the rule‐in zone for 30‐day CDMI were calculated. Results: Of the 1307 patients accrued, 53.6% (700/1307) were male and 58.6% (762/1307) were White, with a mean ± SD age of 57.5 ± 12.7 years. At 30 days, CDMI occurred in 12.9% (168/1307) of participants. The 0/2‐h algorithm ruled out 61.4% (802/1307) of patients. Among rule‐out patients, 1.9% (15/802) experienced 30‐day CDMI, resulting in a sensitivity of 91.1% (95% confidence interval [CI] 85.7%–94.9%) and NPV of 98.1% (95% CI 96.9%–98.9%). The 0/2‐h algorithm ruled in 12.4% (162/1307) patients of whom 61.7% (100/162) experienced 30‐day CDMI. The rule‐in zone specificity was 94.6% (95% CI 93.1%–95.8%) and PPV was 61.7% (95% CI 53.8%–69.2%) for 30‐day CDMI. The 0/2‐h algorithm combined with HEAR score ruled out 30.7% (401/1307) of patients with a sensitivity and NPV for 30‐day CDMI of 98.2% (95% CI 94.9%–99.6%) and 99.3% (95% CI 97.8%–99.8%), respectively. Conclusions: The hs‐cTnT 0/2‐h algorithm ruled out most patients. With NPV of <99% for 30‐day CDMI, the hs‐cTnT 0/2‐h algorithm, many emergency physicians may not consider it safe to use for U.S. ED patients. When combined with a low‐risk HEAR score, NPV was >99% for 30‐day CDMI at the cost of reduced efficacy. [ABSTRACT FROM AUTHOR]

The diagnostic performance of the high‐sensitivity troponin T (hs‐cTnT) European Society of Cardiology (ESC) 0/1‐h algorithm in sex and race subgroups of US Emergency Department (ED) patients is unclear. A pre‐planned subgroup analysis of the STOP‐CP cohort study was conducted. Participants with 0‐ and 1‐h hs‐cTnT measures from eight US EDs (1/2017 to 9/2018) were stratified into rule‐out, observation, and rule‐in zones using the hs‐cTnT ESC 0/1 algorithm. The primary outcome was adjudicated 30‐day cardiac death or MI. The proportion with the primary outcome in each zone was compared between subgroups with Fisher's exact tests. The negative predictive value (NPV) of the ESC 0/1 rule‐out zone for 30‐day CDMI was calculated and compared between subgroups using Fisher's exact tests. Of the 1422 patients enrolled, 54.2% (770/1422) were male and 58.1% (826/1422) white with a mean age of 57.6 ± 12.8 years. At 30 days, cardiac death or myocardial infarction (MI) occurred in 12.9% (183/1422) of participants. Among patients stratified to the rule‐out zone, 30‐day cardiac death or MI occurred in 1.1% (5/436) of women versus 2.1% (8/436) of men (p =.40) and 1.2% (4/331) of non‐white patients versus 1.8% (9/490) of white patients (p =.58). The NPV for 30‐day cardiac death or MI was similar among women versus men (98.9% [95% confidence interval, CI: 97.3–99.6] vs. 97.9% [95% CI: 95.9–99.1]; p =.40) and among white versus non‐white patients (98.8% [95% CI: 96.9–99.7] vs. 98.2% [95% CI: 96.5–99.2]; p =.39). NPVs <99% in each subgroup suggest the hs‐cTnT ESC 0/1‐h algorithm may not be safe for use in US EDs. Trial Registration: High‐Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP‐CP; ClinicalTrials.gov: NCT02984436; https://clinicaltrials.gov/ct2/show/NCT02984436). [ABSTRACT FROM AUTHOR]

Background: Identifying and eliminating racial health care disparities is a public health priority. However, data evaluating race differences in emergency department (ED) chest pain care are limited. Methods: We conducted a secondary analysis of the High‐Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP‐CP) cohort, which prospectively enrolled adults with symptoms suggestive of acute coronary syndrome without ST‐elevation from eight EDs in the United States from 2017 to 2018. Race was self‐reported by patients and abstracted from health records. Rates of 30‐day noninvasive testing (NIT), cardiac catheterization, revascularization, and adjudicated cardiac death or myocardial infarction (MI) were determined. Logistic regression was used to evaluate the association between race and 30‐day outcomes with and without adjustment for potential confounders. Results: Among 1454 participants, 42.3% (615/1454) were non‐White. At 30 days NIT occurred in 31.4% (457/1454), cardiac catheterization in 13.5% (197/1454), revascularization in 6.0% (87/1454), and cardiac death or MI in 13.1% (190/1454). Among Whites versus non‐Whites, NIT occurred in 33.8% (284/839) versus 28.1% (173/615; odds ratio [OR] 0.76, 95% confidence interval [CI] 0.61–0.96) and catheterization in 15.9% (133/839) versus 10.4% (64/615; OR 0.62, 95% CI 0.45–0.84). After covariates were adjusted for, non‐White race remained associated with decreased 30‐day NIT (adjusted OR [aOR] 0.71, 95% CI 0.56–0.90) and cardiac catheterization (aOR 0.62, 95% CI 0.43–0.88). Revascularization occurred in 6.9% (58/839) of Whites versus 4.7% (29/615) of non‐Whites (OR 0.67, 95% CI 0.42–1.04). Cardiac death or MI at 30 days occurred in 14.2% of Whites (119/839) versus 11.5% (71/615) of non‐Whites (OR 0.79 95% CI 0.57–1.08). After adjustment there was still no association between race and 30‐day revascularization (aOR 0.74, 95% CI 0.45–1.20) or cardiac death or MI (aOR 0.74, 95% CI 0.50–1.09). Conclusions: In this U.S. cohort, non‐White patients were less likely to receive NIT and cardiac catheterization compared to Whites but had similar rates of revascularization and cardiac death or MI. [ABSTRACT FROM AUTHOR]

The article focuses on responding to concerns regarding troponin thresholds for myocardial infarction risk assessment, addressing issues such as the use of high-sensitivity cardiac troponin T (hs-cTnT) algorithms and the importance of chest pain timing in patient stratification. Topics include the diagnostic performance of the hs-cTnT 0/2-hour algorithm, sensitivity analysis based on chest pain onset time, and the influence of disease prevalence on reported negative predictive values.

A personal narrative is presented which explores the author's experience in attending patients at the community health clinic in the U.S.

A personal narrative is presented which explores the author's experience of being a daddy to his six-week-old son at a time when he got sick.